Introduction: Our objective was to evaluate the cost-effectiveness of obtaining preoperative type and screen (TS) for common urological procedures and to determine patient and hospital factors associated with receiving blood transfusions. Methods: Retrospective database analysis of the 2006-2015 Nationwide Inpatient Sample (NIS) was performed to identify patients undergoing a variety of urological procedures. A total of 4,113,144 cases were identified. Transfusion rates were then determined from NIS data, and multivariate regression analyses was used to identify factors associated with transfusions. A cost-effectiveness analysis was performed to determine the incremental cost-effectiveness ratio (ICER) of obtaining preoperative TS to prevent an emergencyrelease transfusion (ERT), with a willingness-to-pay threshold of $1,500. Results: Transfusion rates of common urological procedure ranged from .91% to 33.14%. On multivariate modeling, all comorbidities with the exception of obesity were significantly associated with blood transfusion. Some examples included diabetes (OR, 1.26; 95% CI, 1.19-1.33), liver disease (OR, 1.20; 95% CI, 1.13-1.29), and metastatic cancer (OR, 2.69; 95% CI 2.54-2.85) (p < 0.01 for all). One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative TS. The ICER of preoperative TS for radical prostatectomy (transfusion rate = 3.88%) and penile implants (transfusion rate = 0.91%) were $1,607 and $7,709 per ERT prevented, respectively. Conclusion: Based on a large national database, institutions should consider a risk of transfusion greater than or equal to 4.12% to justify a preoperative TS. A selective TS policy for high-risk patients may reduce costs and unnecessary workload for laboratory staff.
Volin J, Herndon P, Spillinger A, Karabon P, Blumline J, Tran D, et. al. Is a preoperative type and screen required in patients undergoing common urological procedures? A cost-benefit analysis. Paper presented at : The 95th Annual Meeting of the North Central Section of the AUA; 2021 Oct 6-9; Chicago, IL. Available at:https://ncsaua.org/docs/meetings/ncs2110/ncs-2021-program-book.aspx